The Contradictory U.S. Position on Global AIDS

During the very same week that Secretary of State Hillary Clinton delivered a much-praised speech saying that the Obama administration would prioritize the fight against global AIDS, the U.S. was participating in multilateral free trade talks in which it is pushing for measures that threaten to undermine access to HIV treatment in the countries involved in the negotiations. Through the Trans-Pacific Partnership, the U.S. is seeking to impose draconian intellectual property provisions. This rigid U.S. position was made evident when government documents were leaked and groups such as Doctors Without Borders and Public Citizen have responded with advocacy campaigns.

Negotiators are currently hashing out a plan for the free trade agreement in Honolulu at the Asia Pacific Economic Cooperation Leaders’ meeting. The other eight countries involved are Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, and Vietnam.

The U.S. is aiming for strict intellectual property regulations that would benefit its own pharmaceutical industry and would undercut access to low-cost generic drugs. One such measure is data exclusivity: Only large pharmaceutical companies, but not generic drug makers, would be able to cite data from clinical trials in their attempt to receive approval from regulatory agencies. Another example is that drug regulators would be barred from approving new drugs that would pose a threat to existing patents — clearly a way to ensure that low-cost drugs don’t displace those produced by big pharmaceutical companies.

The ability for the U.S. government to suggest such harsh measures can be traced to shortcomings in the international trade regime. In 1994, the World Trade Organization-sanctioned Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) established certain minimum standards but left countries with the flexibility to adopt more stringent regulations. Yet this opened the opportunity for the U.S. to bully other countries into complying with its trade agenda.

“The U.S knew it was going to continue to pressure countries because it didn’t get everything it wanted in the TRIPS agreement,” said Brook Baker, a professor at Northeastern University Law School. “Pharmaceutical companies and the U.S. Trade Representative both knew they wanted to get more bites at the apple. The U.S. has always argued that because Article 1 [of TRIPS] allows countries to adopt stronger measures, the U.S. can strong-arm other countries.”

As a result, the U.S. lures countries into adopting certain intellectual property standards by bribing trade officials and proposing attractive bilateral trade relationships, Baker said. There is nothing in international law that prevents the U.S. from going around the world pressuring foreign governments into accepting its terms.

“Countries are always free and should say, 'We are not doing more than TRIPS requires',” Baker said.

To me, that underlines the importance of the TPP countries mustering the political will to prioritize pro-poor public health strategies. This involves not only taking action on issues such as AIDS but also resisting efforts by the U.S. to impose its own economic interests.

In fact, this isn’t the first time that I’ve seen American exceptionalism come at the expense of human rights. In the PBS documentary “The Reckoning” — chronicling the International Criminal Court — I remember how the U.S. threatened to damage trade relations with countries that joined the court. In that film, John Bolton, the former U.S. ambassador to the United Nations, arrogantly professes that he is an “American exceptionalist.”

What’s most striking to me about the rigid U.S. stance is that it’s directly at odds with U.S. claims of leadership on fighting global AIDS. The 2003 establishment of the President’s Emergency Plan for AIDS Relief was supposed to signal a comprehensive commitment to fighting AIDS — not merely a display of goodwill. Yet the TPP underlines the very real tensions between U.S. economic interests and development, and it seems that the Obama administration sees the expansion of AIDS treatment as secondary to its trade agenda.

I think there’s a valuable lesson for activists to learn from the Trans-Pacific Partnership. In advocating for U.S. leadership on any international development issue, it’s insufficient to merely demand funding; rather, you have to examine the ways that current policies may be exacerbating the crisis you’re interested in addressing. This calls for more attention to the structural drivers of poverty—the injustices embedded in the inherent wealth divide between industrialized and developing countries.

Baker sees the U.S. position in the TPP as a problem of “policy dominance—the U.S. is saying that the trade interests of its IP industries are always more important than our development agenda,” Baker said.

Thus, I believe the key is for the U.S. government to transform the way it addresses development. A multi-agency effort, bringing together the expertise of the various bureaucratic agencies, must be at the forefront of this effort. This sort of “whole-of-government” approach has been formulated for the Feed the Future initiative, the Obama administration’s comprehensive plan for fighting world hunger. Now, particularly in light of Clinton’s speech designating global AIDS a top priority of the administration, it’s imperative to build a government-wide strategy for tackling the AIDS crisis.